Are there any type 2 diabetes eye problems? The answer to this question is yes there are several diseases that can develop if you are living with diabetes. These diseases include:
- Hyperglycemia induced blurred vision
- Diabetic retinopathy
- Diabetic macular edema
Hyperglycemia Induced Blurred Vision
Hyperglycemia (not to be confused with hypoglycemia) is what you have if your blood glucose (blood sugar) levels are too high due to too much sugar in your blood. This can because by lacking enough insulin to transport the blood sugars into the cells of your body properly and/or your cells are too insulin resistant, meaning that they have an impaired reaction or resistance towards insulin and cannot absorb the blood sugars in your blood effectively. Lacking enough insulin and having insulin resistance both cause high levels of buildup of sugar in your blood.
The high sugar levels or hyperglycemia cause fluid to leak into your eyes. That causes lens of your eyes to swell and change shape, which has an affect your eyes’ seeing ability. This is when things get kind of fuzzy, and you may not be able to see things very well. The blurred vision that can be caused by hyperglycemia is only temporary and can be overcome by simply bringing your glucose level back within normal range.
Diabetic retinopathy (DR) can cause vision problems and blindness in people living with diabetes. It happens when high glucose (blood sugar) levels damage blood vessels in the retina (a thin layer of tissue that lines the back of the inside of the eye and collects light from the lens of the eye, converts the light into neural signals, then send these signals to your brain which enables you to see). There are five stages of diabetic retinopathy:
- Mild nonproliferative diabetic retinopathy
- Moderate nonproliferative diabetic retinopathy
- Severe nonproliferative diabetic retinopathy
- Proliferative diabetic retinopathy
During the early stage of mild nonproliferative diabetic retinopathy (NPDR), your eye(s) has developed at least one micro aneurysm. This means that there is at least one bulge in a small blood vessel of your retina. The bulge looks like tiny red dot. It may cause fluid to leak into the retina. At this early stage, symptoms do not exist at all, or they are mild.
You probably will not have any vision problems at this point. Still, if you are living with type 2 diabetes, it is a good habit to go in and have your doctor give your eyes a check – up at least once a year. NPDR cannot be reversed but you may be able to prevent further complications like vision problems including vision loss in the future.
During the stage of moderate NPDR (this second stage is also called pre-proliferative retinopathy) the blood vessels in the retina begin to swell and/or become blocked, and they may not carry blood as well as they used to. The inability to carry blood causes physical changes to your retina. These changes can pave the way to diabetic macular edema or DME (discussed below).
Also, micro aneurysms, hemorrhages, cotton – wool spots (CWS) and hard exudates occur during this secondary stage of NPDR.
Hemorrhages in your eye can look like little red spots just like micro aneurysms, but where micro aneurysms are small bulges, hemorrhages are broken blood vessels in the eye. A hemorrhage is what happens when a micro aneurysm ruptures. Cotton wool spots are tiny white areas on the retina due to lack of blood flow to the tiny retinal blood vessels. Finally, hard exudates are plaques composed of serum proteins, lipids and protein that leak from the impaired retina of the eye. Hard exudates look like small white or yellowish white deposits and is also called pus.
Approaching the third stage of diabetic retinopathy (DR) is severe NPDR. At this stage of DR, there is an increase of the same of what takes place in stage two, including micro aneurysms, hemorrhages and more blocked blood vessels preventing the flow of blood. This leads to the retina no longer receiving adequate blood flow in areas. These blood vessels may close off completely causing blurred vision. Without the proper blood flow, the retina cannot replace damaged blood vessels by growing new ones.
After severe NPDR, we arrive at the fourth and final stage of DR called proliferative diabetic retinopathy (PDR). In this stage, the lack of blood will trigger the retina to create new blood vessels. They will begin to grow but they will be weak, abnormal and they will leak blood. The bleeding of leaked blood can cause scar tissue. This leak will also lead to vision loss. Blindness is also a possibility at this point.
If you are subject to vision loss of any kind, it is important to notify your doctor as soon as possible. The loss of vision may or may not be reversible and there are treatments that can prevent further vision loss.
Diabetic Macular Edema
The macula is at the center of the retina. This macula is responsible for your sharp central vision. It is what you need for seeing faces, reading, and driving. When someone living with diabetes maintain high blood sugar levels, tiny blood vessels of the retina are damaged, developing micro aneurysms.
A micro aneurysm is a tiny bulge in a blood vessel, and it may leak fluid or blood into the retina. The leaking fluid can cause edema (swelling) to the macula of the retina. When a situation like this occurs, you are likely to have eye problems such as blurred vision, double vision, vision loss and blindness. Diabetic macular edema (DME) usually occurs during the progression of diabetic retinopathy (DR).
The natural lens of your eye works to focus light beams onto the light – sensitive retina. The tissue of the lens is transparent. This allows the light to easily enter the eye. Cataract is what happens when proteins and fibers in the lens breaks down, clumps together and causes this lens to get cloudy. That is when your eyesight becomes blurry or less colorful.
This changing of the tissue is usually caused by aging or injury to the lens. It can also be caused by inherited genetic disorders, other eye diseases, previous eye surgery, and conditions such as out of control diabetes. Some symptoms of cataracts are:
- Double vision in one eye
- Blurred or clouded vision
- Problems seeing at night or in dim lighting
- Seeing “halos” around light
- Frequently changing eye prescriptions
- Fading or yellowing of colors
At first, cataracts may be very mild and not so severe, affecting only a small part of the eye. Usually, it will eventually affect both eyes, just at different rates. If you begin to experience a change in vision, difficulty doing your usual tasks such as driving or reading, have eye aches, or headaches, then you should make an appointment to be safe. Cataracts develop slowly over time and can be surgically removed to restore your vision.
Glaucoma is one of the leading causes of irreversible blindness in adults. It is a disease that damage the optic nerve of the eye. The optic nerve is a bundle of about 1 million nerve fibers, is connected to the retina in the back of the eye, then is connected to your brain on the other end.
The optic nerve responsibility is to send visual information by electrical impulses from the retina to the brain for the brain’s visual centers to decipher. The optic nerve plays a role in your vision, facilitating the eye’s focus on things in the world, and constricting the pupil in response to light.
Glaucoma is when the optic nerve is dying over time. The optic nerve is dying due to high pressure in the fluid that is inside the eye. This high pressure compresses the optic nerve and causes cells to die. As these cells die, vision is loss. Slowly, your peripheral vision will be the first to go until you have complete tunnel vision. If not treated, the glaucoma will progress until you are completely blind. Remedies include eye drops to promote the outflow of fluid from the eye, which reduces pressure, to surgery that is needed to decrease this high pressure.
Vision loss happens over a long period of time and there are no early symptoms. Regular eye examination can catch glaucoma even before vision is lost. If you lose any vision, it is irreversible, but surgery may preserve the vision that you already have or at least slow down the process.
Prevention of Diabetic Eye Diseases
Of course, prevention and good management to limit your chances of having, or at least having early development of a diabetic eye disease will include keeping your diabetes under control. Healthy management of your diabetes includes:
- Monitoring and managing your blood glucose (blood sugar) level
- Monitoring and managing high blood pressure
- Monitoring and managing your cholesterol levels
- Stop smoking or do not start smoking
- Eat healthy foods
- Get physically active
Some other prevention methods for diabetic eye disease to add are:
- Get an eye exam at least once a year
- Protect your eyes from the sun
- Reduce screen time
- Reduce alcohol consumption
- Seek help early
 Barden, A. (2022, April). Diabetic retinopathy: Types and stages. All About Vision. https://www.allaboutvision.com/conditions/diabetic-retinopathy-types-stages/#:~:text=Moderate%20nonproliferative%20retinopathy%3A%20mid-stage%20of%20DR%20Blood%20vessels%2C,spots%E2%80%9D%20also%20occur%20during%20this%20stage%20of%20DR.
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